2007～2009年住院患者下呼吸道感染病原菌组成及常见高耐药菌变化

目的分析3年来笔者所在医院住院患者下呼吸道感染病例的病原菌组成及常见高耐药菌株变化。方法回顾性分析、对比笔者所在医院住院患者2007～2009年间所分离的下呼吸道病原菌的组成及常见耐药菌比例变化。结果3年间各分离病原菌中革兰阴性杆菌和阳性球菌比分圳为1．41：1、1．76：1、1．77：1，病原菌组成中以肺炎链球菌、流感嗜血杆菌、克雷伯菌为多。高耐药菌株比例分别为（PNSP，62％、66％、71％；产ESBLs的大肠埃希菌，25％、34％、41％；产ESBLs克雷伯菌，17％、26％、26％；产高水平AMPC酶的阴沟肠杆菌，40％、80％、88％；产金属β-内酰胺酶的铜绿假单胞菌，16％、29％、34％；产金属β-内酰胺酶的不动杆菌，25％，41％、59％；MRSA，45％、60％、66％；HLAR肠球菌，50％、56％、71％）。结论下呼吸道感染住院患者的病原菌的主要仍然是肺炎链球菌、流感嗜血杆菌、克雷伯菌等常见呼吸道感染菌；由革兰阴性杆菌引起的感染比例呈现上升趋势，高耐药菌普遍呈现上升，因此重视病原菌分离和注重常见高耐药菌株变化，以有效控制感染的发生。

The distribution of lower respiratory tract pathogens and diversify of the common high level drug resistanceisolates in 2007 - 2009 years

Objective To explore the distribution of lower respiratory tract pathogens and diversify of the common high level drug resistance isolates in three years. Methods By retrospective study of the cases that were performed sputum culture in our hospital in 2007 - 2009, total isolates and the distribution of lower respiratory tract pathogens and proportion of the common high level drug - resistance isolates were statistically analyzed yearly. Results In the bacterial isolates of the three years , the ratio of gram - negative bacilli to gram - positive cocci were 1.41 ： 1,1.76 ： 1,1.77 ： 1. The major lower respiratory tract pathogens of inpatients were remaining S. pneumoniae, H. influenzae , Ps. aeruginosa , K. pneumoniae et al. The proportion of the common high level drug -resistance isolates were remaining higher （PNSP,62% ,66% ,71% ; ESBLs producted E. coli,25% ,34.% ,41% ; ESBLs producted Klebsiella, 17% ,26% ,26% ; high level AMPC β -lactamase producted E. cloacae, 40% ,80% ,88% ; Metallo-β -lactamase producted Ps. aeruginosa, 16% ,29% ,34% ;Metallo-β -lactamase producted Acinetobacter, 25 %, 41% , 59% ; MRSA, 45 % , 60%, 66% ; HLAR Enteroeoccus, 50%, 56%, 7 1% ）. Conclusion The major lower respiratory tract pathogens of inpatients were remaining S. pneumoniae , H. influenzae , Kleb-siella et al; the infections due to gram -negative bacilli are raising ; the high level drug -resistance isolates are Generally upward, so we should pay attention on the pathogens isolation and the changes in high - resistant strains, in order to effectively control the infection.